Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

An embedding technique to determine ττ backgrounds in proton-proton collision data

An embedding technique is presented to estimate standard model tau tau backgrounds from data with minimal simulation input. In the data, the muons are removed from reconstructed mu mu events and replaced with simulated tau leptons with the same kinematic properties. In this way, a set of hybrid events is obtained that does not rely on simulation except for the decay of the tau leptons. The challenges in describing the underlying event or the production of associated jets in the simulation are avoided. The technique described in this paper was developed for CMS. Its validation and the inherent uncertainties are also discussed. The demonstration of the performance of the technique is based on a sample of proton-proton collisions collected by CMS in 2017 at root s = 13 TeV corresponding to an integrated luminosity of 41.5 fb(-1).Peer reviewe

Performance of missing transverse momentum reconstruction in proton-proton collisions at root s=13 TeV using the CMS detector

The performance of missing transverse momentum ((p) over right arrow (miss)(T)) reconstruction algorithms for the CMS experiment is presented, using proton-proton collisions at a center-of-mass energy of 13 TeV, collected at the CERN LHC in 2016. The data sample corresponds to an integrated luminosity of 35.9 fb(-1). The results include measurements of the scale and resolution of (p) over right arrow (miss)(T), and detailed studies of events identified with anomalous (p) over right arrow (miss)(T). The performance is presented of a (p) over right arrow (miss)(T) reconstruction algorithm that mitigates the effects of multiple proton-proton interactions, using the "pileup per particle identification" method. The performance is shown of an algorithm used to estimate the compatibility of the reconstructed (p) over right arrow (miss)(T) with the hypothesis that it originates from resolution effects.Peer reviewe

Preoperative Localization in Colonic Surgery (PLoCoS Study): a multicentric experience on behalf of the Italian Society of Colorectal Surgery (SICCR)

: The aim of this prospective multicentric study was to compare the accurate colonic lesion localization ratio between CT and colonoscopy in comparison with surgery. All consecutive patients from 1st January to 31st December 2019 with a histologically confirmed diagnosis of dysplastic adenoma or adenocarcinoma with planned elective, curative colonic resection who underwent both colonoscopy and CT scans were included. Each patient underwent conventional colonoscopy and CT to stage the tumour, and the localization results of each procedure were registered. CT and colonoscopic localization were compared with surgical localization, adopted as the reference. Our analysis included 745 patients from 23 centres. After comparing the accuracy of colonoscopy and CT (for visible lesions) in localizing colonic lesions, no significant differences were found between the two preoperative tools (510/661 vs 499/661 correctly localized lesions, p = 0.518). Furthermore, after analysing only the patients who underwent complete colonoscopy and had a visible lesion on CT, no significant difference was observed between conventional colonoscopy and CT (331/427 vs 340/427, p = 0.505). Considering the intraoperative localization results as a reference, a comparison between colonoscopy and CT showed that colonoscopy significantly failed to correctly locate the lesions localized in the descending colon (17/32 vs 26/32, p = 0.031). We did not identify an advantage in using CT to localize colonic tumours. In this setting, colonoscopy should be considered the reference to properly localize lesions; however, to better identify lesions in the descending colon, CT could be considered a valuable tool to improve the accuracy of lesion localization

Anastomosis configuration and technique following ileocaecal resection for Crohn\u2019s disease: a multicentre study

A limited ileocaecal resection is the most frequently performed procedure for ileocaecal CD and different anastomotic configurations and techniques have been described. This manuscript audited the different anastomotic techniques used in a national study and evaluated their influence on postoperative outcomes following ileocaecal resection for primary CD. This is a retrospective, multicentre, observational study promoted by the Italian Society of Colorectal Surgery (SICCR), including all adults undergoing elective ileocaecal resection for primary CD from June 2018 May 2019. Postoperative morbidity within 30 days of surgery was the primary endpoint. Postoperative length of hospital stay (LOS) and anastomotic leak rate were the secondary outcomes. 427 patients were included. The side to side anastomosis was the chosen configuration in 380 patients (89%). The stapled anastomotic (n = 286; 67%), techniques were preferred to hand-sewn (n = 141; 33%). Postoperative morbidity was 20.3% and anastomotic leak 3.7%. Anastomotic leak was independent of the type of anastomosis performed, while was associated with an ASA grade 65 3, presence of perianal disease and ileocolonic localization of disease. Four predictors of LOS were identified after multivariate analysis. The laparoscopic approach was the only associated with a reduced LOS (p = 0.017), while age, ASA grade 65 3 or administration of preoperative TPN were associated with increased LOS. The side to side was the most commonly used anastomotic configuration for ileocolic reconstruction following primary CD resection. There was no difference in postoperative morbidity according to anastomotic technique and configuration. Anastomotic leak was associated with ASA grade 65 3, a penetrating phenotype of disease and ileo-colonic distribution of CD

Measurement of electroweak production of a W boson in association with two jets in proton-proton collisions at s=\sqrt{s}= 13 TeV

A measurement is presented of electroweak (EW) production of a W boson in association with two jets in proton-proton collisions at $\sqrt{s}=$ 13 TeV. The data sample was recorded by the CMS Collaboration at the LHC and corresponds to an integrated luminosity of 35.9 fb$^{-1}$. The measurement is performed for the $\ell\nu$jj final state (with $\ell\nu$ indicating a lepton-neutrino pair, and j representing the quarks produced in the hard interaction) in a kinematic region defined by invariant mass $m_\mathrm{jj} >$ 120 GeV and transverse momenta $p_\mathrm{T j} >$ 25 GeV. The cross section of the process is measured in the electron and muon channels yielding $\sigma_\mathrm{EW}($Wjj$)=$ 6.23$\pm$0.12 (stat)$\pm$ 0.61 (syst) pb per channel, in agreement with leading-order standard model predictions. The additional hadronic activity of events in a signal-enriched region is studied, and the measurements are compared with predictions. The final state is also used to perform a search for anomalous trilinear gauge couplings. Limits on anomalous trilinear gauge couplings associated with dimension-six operators are given in the framework of an effective field theory. The corresponding 95% confidence level intervals are $-$2.3 $< c_{\mathrm{WWW}}/\Lambda^2 <$ 2.5 TeV$^{-2}$, $-$8.8 $< c_{\mathrm{W}}/\Lambda^2 <$ 16 TeV$^{-2}$, and $-$45 $< c_{\mathrm{B}}/\Lambda^2 <$ 46 TeV$^{-2}$. These results are combined with the CMS EW Zjj analysis, yielding the most stringent limit to date on the $c_{\mathrm{WWW}}$ coupling: $-$1.8 $< c_{\mathrm{WWW}}/\Lambda^2 <$ 2.0 TeV$^{-2}$

Search for supersymmetry in final states with photons and missing transverse momentum in proton-proton collisions at 13 TeV

Results are reported for a search for supersymmetry in final states with photons and missing transverse momentum in proton-proton collisions at the LHC. The data sample corresponds to an integrated luminosity of 35.9 fb$^{-1}$ collected at a center-of-mass energy of 13 TeV using the CMS detector. The results are interpreted in the context of models of gauge-mediated supersymmetry breaking. Production cross section limits are set on gluino and squark pair production in this framework. Gluino masses below 1.86 TeV and squark masses below 1.59 TeV are excluded at 95% confidence level